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    Jenni Bertels   
503-947-7742   

Electronic Data Interchange (EDI)



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EDI Medical Bill Reporting:
 
  Send us an email about EDI Medical Bill Reporting questions
     
  Medical EDI Traffic Report
 
  To obtain Expanded List of Valid Revenue Codes (NUBC webpage)
     
  List of insurers and self-insured employers required to report medical bill data (now Bulletin 359)
     
  List of taxonomy codes that do not require a diagnosis code
 
  Frequently asked questions for EDI medical bill reporting
 
  Rules affecting EDI medical bill reporting - OAR 436-160
       
  Medical Bill Data Element Requirement Table
     
  DN Error Message Table: (PDF) | (Excel)
 
  EDI Medical Billing Trading Partner Profile Form: Trading Partner Profile (Form 4015)
 
  Oregon Data Elements by Source table
 
  Obtain IAIABC EDI Medical Implementation Guide
     
  Release 2 Transition FAQs and Updates
  Transition to ICD-10 Codes (Information)
  Oregon critical access hospitals are not required to report the MS-DRG codes on their inpatient bills. [Most Oregon hospitals are required to report the appropriate MS-DRG codes on their workers' compensation inpatient hospital bills. (4/1/11)]
    The list of required Oregon hospitals can be found in Oregon Administrative Rule 436-009, Appendix A.
 

EDI Proof of Coverage Reporting:
  Division 162 Electronic Data Interchange; Proof of Coverage Rules - Current | Effective 4/1/15
  Oregon EDI Implementation Guide for Proof of Coverage - December, 2010
  Proof of Coverage-Edit matrix/DN-Error Message Table - Current (PDF)| Effective 4/1/15 (PDF, Excel)
  Proof of Coverage Element Requirement Table (Appendix A) - Current (PDF) | Effective 4/1/2015 (PDF, Excel)
  Proof of Coverage Data Element Issuance Conditions (Appendix B) - Effective 4/1/2015 (PDF, Excel)
  Proof of Coverage Event Table (Appendix C) - Effective 4/1/2015 (PDF, Excel)
  Insurer registration requirements
  Employee Leasing Policy Identification
  Proof of Coverage Forms
  • Trading Partner Agreement for Filing Guaranty Contracts through EDI (Form 4820) - For EDI transactions effective before 7/1/2009. Contact the EDI Coordinator in order to use this form.
  • EDI Insurer Profile (Form 4821)| PDF, Word - For EDI transactions effective after 7/1/2009 - Current
  • Proof of Coverage EDI Transmission Profile (Form 4979) | PDF, Word - For EDI transactions effective after 7/1/2009 - Effective 4/1/2005
  For proof of coverage questions or additional information, contact our EDI Coordinator at 503-947-7742 or edinews.wcd@state.or.us.
 
eBilling for Workers' Compensation
  Ebilling rules, companion guide, resources, and more
 

Other resources:
 

HIPAA

 

International Association of Industrial Accident Boards and Commissions (IAIABC)

 

National Council on Compensation Insurance

 

Insurance Services Office



If you have questions about this webpage, please contact Jenni Bertels, 503-947-7742.